Health care in France

Instead, the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded).

Until 2000, coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population.

The French Third Republic followed well behind Bismarckian Germany, as well as Great Britain, in developing the welfare state including public health.

[3] The French medical profession jealously guarded its prerogatives, and public health activists were not as well organized or as influential as in Germany, Britain or the United States.

Success finally came when the government realized that contagious diseases had a national security impact in weakening military recruits, and keeping the population growth rate well below Germany's.

the battered state of the French social security system's finances is causing the growth of France's health care expenses.

recommend a reorganization of access to health care providers, revisions to pertinent laws, a repossession by CNAMTS (French acronym: Caisse Nationale d'Assurance Maladie des Travailleurs Salariés or French National Health Insurance Fund for Salaried Workers) of the continued development of medicines, and the democratization of budgetary arbitration to counter pressure from the pharmaceutical industry.

The insurers are non-profit agencies that annually participate in negotiations with the state regarding the overall funding of health care in France.

Under recent rules (the coordinated consultation procedure, in French: "parcours de soins coordonné"), general practitioners ("médecin généraliste" or "docteur") are expected to act as "gate keepers" who refer patients to a specialist or a hospital when necessary.

Patients pay the additional cost out of pocket, although some complementary policies will cover a limited excess charge.

In the Alsace-Moselle region, due to its special history as having belonged to France and Germany at one time or another, the social security system covers 90% of the global cost.

The fee varies according to the number of pills in the box (duration of treatment supply) and is not reimbursable by any insurance, but there is a maximum charge of €50 per year.

It is reimbursable by complementary insurance, as are new charges of about €0.50-€1.00 when prescriptions are for young children or the elderly, on the grounds the pharmacist must take time to give explanations for such patients.

In 2024, the French government proposed fining patients €5 for missing doctor appointments without a valid excuse, aiming to tackle the issue of 27 million annual no-shows.

Initiatives to address healthcare access in rural areas were also announced, including doubling medical school places by 2027.

In its place a wider levy based on total income has been introduced, gambling taxes are now redirected towards health care and recipients of social benefits also must contribute.

[12] All working people are required to pay a portion of their income into a health insurance fund, which mutualizes the risk of illness and which reimburses medical expenses at varying rates.

All citizens and legal foreign residents of France are covered by one of these mandatory programs, which continue to be funded by worker participation.

Firstly, the different health care funds (there are five: General, Independent, Agricultural, Student, Public Servants) now all reimburse at the same rate.

Secondly, since 2000, the government now provides health care to those who are not covered by a mandatory regime (those who have never worked and who are not students, meaning the very rich or the very poor).

This regime, unlike the worker-financed ones, is financed via general taxation and reimburses at a higher rate than the profession-based system for those who cannot afford to make up the difference.

Finally, to counter the rise in health care costs, the government has installed two plans (in 2004 and 2006), which require most people to declare a referring doctor in order to be fully reimbursed for specialist visits, and which installed a mandatory co-payment of €1 (about US$1.35) for a doctor visit (limited to €50 annually), €0.50 (about US$0.77) for each prescribed medicine (also limited to €50 annually) and a fee of €16–18 ($20–25) per day for hospital stays (considered to be the "hotel" part of the hospital stay; that is, an amount people would pay anyway for food, etc.)

Finally, for fees that the mandatory system does not cover, there is a large range of private complementary insurance plans available.

There are recommendations on clinical practice (RPC), relating to the diagnosis, treatment and supervision of certain conditions, and in some cases, to the evaluation of reimbursement arrangements.

[18] While 99.9% of the French population is covered, the rising cost of the system has been a source of concern,[19][20] as has the lack of emergency service in some areas.

[22][23] Like most countries, France faces problems of rising costs of prescription medication, increasing unemployment, and a large aging population.

[29] The French National Insurance system also pays for a part of social security taxes owed by doctors that agree to charge the government-approved fees.

Fee-for-service rather than limited budgets, with access for patients with public health insurance helped prevent long waits for surgery (Siciliani and Hurst, 2003, pp. 69–70).

This percentage held relatively constant over time, showing that waiting lists in France for appointments and elective surgery are not a new phenomenon.

[35] In terms of health care supply, France has far more doctors per capita than the U.K., Australia, New Zealand, and the U.S.[32] This suggests that while French patients in some cases have similar to current waiting times to the first 3 countries, the number of patients who receive appointments and treatment is significantly higher than in the U.K., Australia and New Zealand (whose global budgets for hospitals also likely capped the supply at lower levels).